TAILIEUCHUNG - Chapter 136. Meningococcal Infections (Part 7)

Complications Patients with meningococcal meningitis may develop cranial nerve palsies, cortical venous thrombophlebitis, and cerebral edema. Children may develop subdural effusions. Permanent sequelae can include mental retardation, deafness, and hemiparesis. The major long-term morbidity of fulminant meningococcemia is the loss of skin, limbs, or digits that results from ischemic necrosis and infarction. Diagnosis Few clinical clues help the physician distinguish the patient with early meningococcal disease from patients with other acute systemic infections. . | Chapter 136. Meningococcal Infections Part 7 Complications Patients with meningococcal meningitis may develop cranial nerve palsies cortical venous thrombophlebitis and cerebral edema. Children may develop subdural effusions. Permanent sequelae can include mental retardation deafness and hemiparesis. The major long-term morbidity of fulminant meningococcemia is the loss of skin limbs or digits that results from ischemic necrosis and infarction. Diagnosis Few clinical clues help the physician distinguish the patient with early meningococcal disease from patients with other acute systemic infections. The most useful clinical finding is the petechial or purpuric rash see Fig. 52-5 but it must be differentiated from the petechial lesions seen with gonococcemia see Fig. 137-2 Rocky Mountain spotted fever see Fig. 167-1 hypersensitivity vasculitis see Fig. 52-4 endemic typhus and some viral infections. In one case series one- half of the adults with meningococcal bacteremia had neither meningitis nor a rash. The definitive diagnosis is established by recovering N. meningitidis its antigens or its DNA from normally sterile body fluids . blood CSF or synovial fluid or from skin lesions. Meningococci grow best on Mueller-Hinton or chocolate blood agar at 35 C in an atmosphere that contains 5-10 CO2. Specimens should be plated without delay. N. meningitidis bacteria are oxidasepositive gram-negative diplococci that typically utilize maltose and glucose. A Gram s stain of CSF reveals intra- or extracellular organisms in 85 of patients with meningococcal meningitis. The latex agglutination test for meningococcal polysaccharides in the CSF is less sensitive. PCR amplification of DNA in buffy coat or CSF samples is more sensitive than either of these tests like the latex agglutination test PCR is unaffected by prior antibiotic therapy as neither method requires viable organisms. Throat or nasopharyngeal specimens should be cultured on Thayer-Martin medium which suppresses the

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